Healthcare point of service adjudication and payment system

ABSTRACT

Systems and methods are described that facilitate providing an online, automated payment architecture that aggregates funds from multiple health-related accounts (e.g., a member&#39;s HSA, an employer&#39;s advance account, etc.) and automatically transfers the aggregated funds to a healthcare provider&#39;s account to pay a bill or invoice. According to other aspects, healthcare fraud is prevented by storing electronic images of members and their dependents, wherein the images can be recalled by a healthcare provider at the point of service to verify that the member or dependent is actually a covered member. In other aspects, the described systems and methods permit members to negotiate reduced invoice payments in exchange for prompt delivery of payment funds.

The present application claims the benefit of U.S. ProvisionalApplication No. 61/348,345, filed May 26, 2010, which is incorporatedherein by reference in its entirety.

BACKGROUND

The subject application relates to a healthcare payment system thatprevents patient fraud and merges healthcare banking (e.g., a healthsavings account, etc.) website information with healthcare insurancewebsite information to facilitate payment to a healthcare provider whileadjudicating the payment. While the described systems and methods relateto healthcare payments, it will be appreciated that the describedfeatures and aspects may find application in other payment systems ormethods, other healthcare information systems, and the like.

Conventional healthcare payment systems involving a health savingsaccount (HSA) or an health reimbursement account (HRA) employ a debitcard system, whereby a patient visits a healthcare provider (e.g., adoctor, a registered nurse practitioner, a clinic, etc.) and uponleaving, pays all or a portion of the bill for the visit via the debitcard. However, a drawback of such systems is that patients don't alwaysknow what to pay or can easily abuse the system by using their medicalfunds for other goods and services other than the required goods orservices allowed by law. Healthcare fraud now amounts to over 150billion dollars a year in the United States. For instance, a coveredmember can buy non-health related items as long as they check out at thepharmacy swipe machine, which is configured in the credit card system asa pharmacy. This would then allow the misuse of the medical funds in anHSA account or other type of medical account. Another type of fraud canbe perpetrated when, for example, an aunt fraudulently takes her nieceor nephew to see a doctor, while claiming that the niece or nephew isactually her child and therefore covered by her family health insuranceplan. This type of fraud occurs quite frequently because there are fewif any measures by which a healthcare provider can verify the identityof a child brought in by an adult, or even that the adult is using afriend's or another person's health card to seek care.

Another type of fraud that frequently occurs with health savingsaccounts occurs at the pharmacy counter in a drug store or the like.Many HSAs permit patients to purchase over-the-counter health-relateditems (e.g., cough medicine, anti-itch creams, etc.) using funds in theHSA, and these purchases are applied to the patient's annual deductible.However, a dishonest patient's often attempt to purchase non-medicalitems in this manner. For instance, a patient may approach the pharmacycounter with a bottle of cough medicine and a candy bar, and attempt topay for both using his HSA debit card. Even if the teller at thepharmacy counter notices that the patient is using and HSA debit card tobuy the candy bar and informs the patient that the candy bar does notqualify as a health-related expense, the patient may merely argue thathe is diabetic and therefore the candy bar is medically qualified as apurchase. In any case, this sort of fraud is common and results inincreased healthcare costs for all patients.

Another type of fraud occurs when the medical provider submits claimsthat are fraudulent without the knowledge of the medical card holder.

Accordingly, there is an unmet need for systems and/or methods thatfacilitate overcoming the aforementioned deficiencies.

BRIEF DESCRIPTION

In accordance with various aspects described herein, systems and methodsare described that facilitate online fund aggregation and healthcareinvoice payment, as well as healthcare fraud prevention. For example, asystem that facilitates online healthcare fund aggregation for paymentof healthcare provider invoices comprises a processor that executescomputer-executable instructions for aggregating funds from multiplehealthcare-related accounts for payment to a healthcare provider, amemory that stores the computer-executable instructions, and a serverthe comprises the processor and memory and provides Internet access tothe processor for fund aggregation and healthcare invoice payment. Theinstructions comprise receiving an invoice which may be electronic froma healthcare provider, accessing a member account belonging to a memberof a healthcare plan, withdrawing funds to pay the invoice amount fromthe member account, if funds are available in the member account,accessing an employer account maintained by an employer providing thehealthcare plan to the member, and withdrawing additional funds from theemployer account to satisfy the invoice amount when the member accountdoes not have sufficient funds to satisfy the invoice amount. Theinstructions further comprise aggregating the funds from the memberaccount and the additional funds from the employer account in anaggregating account (AA), and transferring the aggregated funds from theaggregating account to a healthcare provider account to pay the invoiceamount.

According to another feature described herein, a method for onlinehealthcare fund aggregation for payment of healthcare provider invoicescomprises receiving an invoice from a healthcare provider, accessing amember account belonging to a member of a healthcare plan, withdrawingfunds to pay the invoice amount from the member account, if funds areavailable in the member account, accessing an employer accountmaintained by an employer providing the healthcare plan to the member,and withdrawing additional funds from the employer account to satisfythe invoice amount when the member account does not have sufficientfunds to satisfy the invoice amount. The method further comprisesaggregating the funds from the member account and the additional fundsfrom the employer account in an aggregating account (AA), andtransferring the aggregated funds from the aggregating account to ahealthcare provider account to pay the invoice amount.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a system that facilitates aggregating healthcarepayments from a plurality of sources and remitting the payments to ahealthcare provider (e.g., a doctor or the like) in accordance withvarious aspects described herein.

FIG. 2 illustrates a method for aggregating payment to a healthcareprovider from a plurality of sources, in accordance with various aspectsdescribed herein.

FIG. 3 illustrates a method for preventing healthcare fraud by verifyinguser identity using pre-stored photo information and/or member-specificand provider-specific PINs.

FIG. 4 illustrates a method for aggregating payment to a healthcareprovider from a plurality of sources, in accordance with various aspectsdescribed herein.

DETAILED DESCRIPTION

In accordance with various features described herein, systems andmethods are described that facilitate reducing healthcare fraud andimproving the timeliness of patient payment to a healthcare provider.The described systems and methodologies require both the member and theprovider to enter a PIN number at the time the invoice is processed,thus preventing purely fraudulent submissions of bills by the provideron behalf of the member.

As used herein, “algorithm” or “module” refers to a set ofcomputer-executable instructions stored on a computer-readable mediumand executable by a processor or other computing device, as will beappreciated by those of skill in the art.

With reference to FIG. 1, a system 10 is illustrated that facilitatesaggregating healthcare payments from a plurality of sources andremitting the payments to a healthcare provider (e.g., a doctor or thelike) using an automated clearing house (ACH) transaction protocol, inaccordance with various aspects described herein. The system 10 includesa server 12 (e.g., operated by a healthcare payment service provider)with a processor 14 that executes, and a memory 16 that stores,computer-executable instructions for performing the various functions,methods, techniques, algorithms, etc., described herein. The server iscoupled to the Internet 18, by which it communicates with, accesses,etc., a healthcare provider's account 20 to deposit payments from one ormore sources, including but not limited to a health savings account(HSA) 22, a health reimbursement account (HRA) 24, an employer advanceaccount (EAA) 24, an aggregating account (AA) 28, an omnibus account 30,an individual HSA account, an employer bank account (EBA) 44, etc. TheEBA 44 may be one or more of an employer's bank account, a line ofcredit designated by the employer for healthcare-related expenses, orthe like.

The HSA 22 and the HRA 24 are collectively may be referred to herein as“member accounts.” The EAA 24, EBA 44, and the employer line of creditcollectively may be referred to herein as “employer accounts.”

The HSA may be any of a number of types of HSAs, as are known, intowhich a member patient and/or employer deposit money periodically to beused for health-related expenses. A typical HSA is a medical savingsaccount available to taxpayers in the U.S. who are enrolled in a highdeductible health plan (HDHP). The funds contributed to the account arenot subject to federal income tax at the time of deposit. Unlike aflexible spending account (FSA), funds in an HSA roll over andaccumulate year to year if not spent. HSAs are owned by the individual,which differentiates them from the company-owned HRA, which is analternate tax-deductible source of funds for health-related expenses.

The HRA is typically an employer-funded plan that reimburses employeesfor incurred medical expenses that are not covered by the company'sinsurance plan. Because the employer funds the plan, distributions areconsidered tax deductible to the employer. Reimbursement dollarsreceived by the employee are generally tax free.

The EAA is an employer advance account that is set up by the serviceprovider and into which the employer deposits money and maintains aminimum balance to cover advances to employees who need additional moneyto pay healthcare bills that come due before sufficient funds have beendeposited into the member's HSA.

The aggregating account 26 is set up and maintained by the serviceprovider (e.g., the server 12) and aggregates payments from one or moreof the HSA and the HRA, and one or more of the EAA, the EBA, and theline of credit. According to an example, a member (patient) deposits orhas deposited on his behalf into his HSA $200 a month for a total of$2400 a year. In this example, the member is employed by an employerhaving an EAA, EBA, and/or line of credit and owes $500 for a visit to adoctor, but has only $200 in his HSA. The server routes the $200 fromthe member's HSA to the aggregating account, and routes $300 from theEAA, the EBA, or the line of credit to the aggregating account. Thetotal $500 is then transmitted to the doctor's account as payment forthe visit. Transaction data 32 including payment information such aspayment amount, payment source, etc., is stored in the memory 16, andeach transfer of funds is assigned or associated with a uniqueidentification number (UIDN) (e.g., a tag) 34 that facilitates trackingand updating account information. In this example, the $200 from the HSAand the $300 from the EAA, the EBA, or the line of credit are eachassigned a UIDN that may be cross-referenced (e.g., using a lookup table(LUT) 36 or the like stored in memory 16) to identify the transaction,amount, member ID, doctor ID, and any other relevant informationassociated with the transaction via the UIDN. The member's HSA isflagged as owing $300 to the EAA, the EBA, or the line of credit, fromwhich the $300 was advanced to the member. When a subsequent monthly$200 deposit is made to the member's HSA, the server routes the $200 tothe EAA, the EBA, or the line of credit (i.e., the account from whichthe $300 was borrowed) in partial repayment of the advanced $300 whichis for a specific medical bill, and updates the information associatedwith the transaction via the UIDN. When a next monthly deposit of $200is made into the member's HSA, the server routes $100 to the EAA, theEBA, or the line of credit to complete the repayment of the original$300, and $100 remains in the HSA. Each transfer is executed upon theexecution of one or more payment algorithms or modules 38 (e.g., a setof computer-executable instructions) stored in the memory 16 andexecuted by the processor 14. In this manner, billing is simplified atthe healthcare provider's end, where payment timeliness is improved andtracking is simplified.

The omnibus account 30 may be viewed as a collective HSA account (e.g.,for a plurality of members on an employer's health plan) and ismaintained by the server (the service provider) to control payment dataand funds from multiple members' HSAs, employers' EAAs, EBAs, lines ofcredit, and/or HRAs in order to simplify payment to a healthcareprovider. For example an employer may have 100 employees on itshealthcare plan, and monthly contributions for all employees may betransferred to the omnibus account. Any contributions or paymentsattributable to individual members' HSAs are tracked by UIDNs associatedwith the lump sum contributions or payments and stored in the LUT 36. Inanother example, the lump payment may be transferred from a single HSA22 or the aggregating account 28, e.g., in a case where only a singleemployee owes a payment to the healthcare provider.

According to another example, an employer 40 is provided with a softwareproduct 42 (e.g., computer-executable instructions, program(s),routine(s), algorithm(s), etc. persistently stored to acomputer-readable medium and executed by a processor) that tracks anamount that each employee needs to pay to his or her HSA. The softwareproduct (optionally upon the employer's approval), sends a lump sumamount through the SPS 12 to the employer's bank account 44, which thentransfers the lump sum to the service provider's omnibus account 30. Theservice provider's server 12 has stored in memory 16 employee censusinformation 46 that is analyzed by the processor 14 upon execution ofthe payment algorithm(s) 38 to identify portions of the omnibus paymentas originating from individual employees' HSA accounts. The depositedamounts are then tracked as individual employees' contribution amounts.If payments are to be made, in one example, if a total of $1000 istransferred to the omnibus account for three employees who respectivelyowe $200, $300, and $500 to a given healthcare provider, then a tablelookup is performed to cross reference UDIN's associated with the $1000omnibus payment with UIDNs for the three employees. Separate paymentsare then transferred from the service provider's omnibus account 30 tothe healthcare provider's account 20 for the three employees in thethree respective dollar amounts. As will be appreciated by one of skillin the art, the memory 16 additionally stores member account information48 and employer account information 50 that facilitates thehere-described transactions.

As previously mentioned, the system 10 comprises the processor 14 thatexecutes, and memory 16 that stores, computer-executable instructionsand/or computer-readable data (e.g., a software package or product) forperforming the various techniques and/or methods described herein. Thememory 16 may be a computer-readable recording medium on which a controlprogram or software product is recorded, such as a disk, hard drive, orthe like. Common forms of computer-readable media include, for example,floppy disks, flexible disks, hard disks, magnetic tape, or any othermagnetic storage medium, CD-ROM, DVD, or any other optical medium, aROM, a PROM, an EPROM, a FLASH-EPROM, or other memory chip or cartridge,or any other tangible medium from which a computer can read and use.Alternatively, the methods may be implemented in a transmittable carrierwave in which the control program is embodied as a data signal usingtransmission media, such as acoustic or light waves, such as thosegenerated during radio wave and infrared data communications, and thelike.

It will be appreciated that all financial transfers, transactions, etc.,and any appended health-related patient information is encrypted using asecure socket layer (SSL) 128-bit encryption protocol.

The following description provides a plurality of examples in which thesystems and methods described herein may be implemented, and/oradvantages that are achieved using the system of FIG. 1 and/or themethods described herein.

In one example, members and their dependents (i.e., children or otherfamily members covered under the employer's insurance plan or selffunded plan) are photographed, and member photo data 52 is stored in thememory 16. The member photo data 52 may be accessed by a healthcareprovider system 54 (e.g., a physician's computer system or network, atthe point of service, etc.,) when a member visits the provider'shealthcare facility, in order to verify the identity of the member orthe dependent to prevent fraud (e.g., to prevent a scenario in which anuncle brings a nephew to the facility and claims the nephew is a son orother covered dependent on a family plan). In the illustratedembodiment, member photo data is stored in the memory 16, and accessibleby the employee system (e.g. a computer system or network) via theInternet 18. In an alternative embodiment, the member photo data 52 isstored locally (e.g., downloaded from the server memory 16) on thehealthcare provider's system or network 54. In this manner, varioustypes of healthcare fraud are mitigated.

According to another example, the processor 14 analyzes transaction datato determine whether a particular purchase (e.g., using an HSA debitcard at a pharmacy or other retail counter or website) or a particularprocedure at a healthcare provider (e.g., a cosmetic procedure notcovered by the member's insurance policy) should be reviewed. If so,then the processor executes a “trigger review” algorithm or module 56that sends an alert to an insurance provider 58 and/or the employersystem 40 to review the member's purchase or procedure to ensure that itis covered and not fraudulent.

In another example, the member account data 48 includes a uniquepersonal identification number (PIN) for each member, which the memberinputs into the system at the place of service of the healthcareprovider at each visit, which identifies the member and his or herdependents. For instance, the PIN may be used to retrieve member accountdata 48, member photo data 52, etc., in order to mitigate healthcarefraud. In another embodiment, the provider submits the invoice using hisor her specific PIN number in order to mitigate healthcare fraud.

It will be appreciated that other types of member identificationmeasures, techniques, procedures, etc., may be employed in conjunctionwith the various systems and methods described herein, and that thedescribed systems and methods are not limited to PIN numberidentification techniques. For instance, biometric systems (e.g., retinascan, fingerprint scan, face recognition, or the like) may be employedto identify the member and/or the provider.

According to other examples described herein, the member is not requiredto present a debit card or other payment form during his or her visit.Rather, the member provides insurance or health plan information (e.g.,healthcare company group number, patient number, etc.) and the server 12provides all relevant information (e.g., member account data 48,employer account data 50, member photo data 52, healthcare plan coveragedata, census data 46, etc.) to the healthcare provider.

In another example, the system offers a reduced payment to thehealthcare provider 54 in exchange for immediate or prompt acceptance.For example the payment algorithm(s) 38 may offer the healthcareprovider a fixed amount or predetermined percentage (e.g., 60%, 80%,90%, or some other predetermined percentage of a preset fee schedulesuch as the CMS (medicare) fee schedule or Preferred ProviderOrganization (PPO) so as to adjust the amount owed by a given member (oremployer) in return for the healthcare provider accepting the paymentwithin a predetermined time period (e.g., one hour, six hours, onebusiness day, 5 business days, one month, etc.). In this manner, thehealthcare provider is rewarded with prompt payment, and the memberand/or employer saves valuable pre-tax HSA dollars or employer dollars.In a related example, the payment algorithm(s) 38 offer the healthcareprovider a tiered payment percentage (e.g., 90% if accepted immediately,80% if accepted within 1-24 hours, 70% if accepted within 24-72 hours,etc.) in order to encourage the healthcare provider to accept a reducedamount quickly while saving money for the member and/or employer. In arelated example, the payment algorithm 38 offers the healthcare providersome percentage of a payment that would be received under Medicare, suchas 90%, 100%, 103%, 105%, etc, as a standard payment offer.

According to another example, the photo data 52 is made available to apharmacy system 60 to prevent healthcare fraud (e.g., a non-member usinga member's account or debit card to purchase health-related itemscovered under the member's HSA.

In yet another example, the server provides to the members a website onwhich HSA bank account, healthcare provider claims, etc., are merged.The website is managed by the service provider.

In another example the service provider server 12 processes interest andperformed other calculations related to monies owed by members and/oremployers for healthcare services rendered by the healthcare provider.

According to another example, patients or members are permitted (via theservice provider) to negotiate payments for rendered healthcareservices. For instance, a patient may offer the healthcare provider atiered payment percentage (e.g., 90% if accepted immediately, 85% ifaccepted within 1-24 hours, 75% if accepted within 24-72 hours, etc.) inorder to encourage the healthcare provider to accept a reduced amountquickly while saving money for the member and/or employer. In a relatedexample the member may offer the healthcare provider a reduced amount(e.g., 70% of the bill) if accepted promptly, as opposed to the optionof submitting the requisite forms and waiting for payment to clear theregular channels if the reduced amount is not accepted. In this manner,the healthcare provider is incentivized to accept a reduced payment inexchange for prompt payment. Alternatively, the healthcare provider canaccept delayed payment in exchange for receiving the full invoiceamount. In another example the member may ask the provider for a furtherdiscount for personal business reasons. Such discounts granted aretracked and this data is provided to other members.

In another example, a member webpage 62 is accessible by members whoseemployers subscribe to or otherwise use the service. The webpageaggregates member HSA bank account information, insurance providerinformation, claims information, etc., for the member. Surveys may bepresented to members asking a few questions by which the healthcareprovider visited by the member may be ranked. The questions may includewithout limitation subjects related to the duration of the member's waitat the healthcare provider's office, whether the member's expectationswere met, whether the member would return to or otherwise recommend thehealthcare provider, etc. In accordance with other aspects, the webpage62 presents a breakdown of member spending (e.g., dental, eye, medical,cosmetic, etc.).

According to other features, the payment algorithm 38 encourages doctoracceptance of payment. For instance, if the doctor accepts the offerpayment immediately, he will receive payment within a predetermined timeperiod (e.g., 72 hours), and he can avoid having to fill out forms tosubmit a request for payment through the usual channels, sendingreminders and having to bill the member, etc.

The system further includes a pharmacy benefit manager (PBM) module 64,which ensures that a pharmacy that services a member whose employer usesthe system 10 will receive payment for services or pharmaceuticalsrendered within a predetermined time period (e.g., 30 days or the like).

According to another feature of the herein-described systems andmethods, a healthcare provider can attach medical reports directly to abill or invoice via the Internet for documentation (for utilizationreviews, etc.). In this manner, if a review of a claim is triggered(e.g., by the triggering algorithm 56), the insurance provider 58 canreadily evaluate whether the procedure was necessary, covered, whetherthe diagnosis was correct, etc. For instance, the processor may executeinstructions for analyzing a submitted claim or invoice to identify anysuspect treatments, prescriptions, charges etc. (e.g., based on acomparison of the invoice to a standardized or predetermined list ofaccepted treatments, prescriptions, charges, etc.). If one or moresuspect events is present, the processor executes the trigger reviewmodule or algorithm 56 to flag the invoice or claim for review (e.g., bythe service provider or the insurance provider. However, the healthcareprovider is permitted to append documentation (i.e., medical reports,diagnoses, etc.) in support of the charges in the invoice to assist theinsurance provider in approving the claim, which in turn expeditespayment to the healthcare provider.

In another example members can access the webpage 62 to identifyhealthcare providers that accept discounted payments in exchange forrapid payment. For example, providers may be ranked according to thesize of the discount they typically accept (e.g., 50%, 40%, 30%, etc.)and members can select a healthcare provider accordingly. The providerbenefits from accepting greater discounts by increased patient base andrapid payment (e.g., within 72 hours or some other predeterminedperiod), and the member benefits from being able to identify ahealthcare provider with reasonable prices.

FIGS. 2-4 illustrate a method related to integrating healthcareinsurance, claims, payment, and banking, in accordance with variousfeatures. While the methods are described as a series of acts, it willbe understood that not all acts may be required to achieve the describedgoals and/or outcomes, and that some acts may, in accordance withcertain aspects, be performed in an order different that the specificorders described. The methods of FIGS. 2-4 may be implemented on acomputer 200, as described below. Additionally, it will be appreciatedthat the methods of FIGS. 2-4 may be performed separately or inconjunction with each other.

FIG. 2 illustrates a method for aggregating payment to a healthcareprovider from a plurality of sources, in accordance with various aspectsdescribed herein. At 100, an invoice is received from a healthcareprovider that has provided a health-related service or product to amember of an employer's health plan. At 102, the member's member account(e.g., HSA, HRA, or the like) is accessed to retrieve funds for paymentto the healthcare provider. That is, upon signing up for the service,the member authorizes the service to access the member account asnecessary to retrieve funds for paying healthcare invoices.Additionally, a determination is made regarding whether there areinsufficient funds in the member account, in which case the serviceprovider accesses related one or more employer accounts (e.g., EAA, EBA,line of credit, etc.) to withdraw additional funds to fully pay theamount listed on the invoice. At 104, funds from the member account andfunds from the employer account are aggregated. At 106, each amountwithdrawn from each account is associated with a UIDN, as describedabove, to facilitate transaction tracking and member payback of fundsborrowed from the advance account. At 108, the aggregated funds aretransmitted to the healthcare provider's account to satisfy the debtlisted on the invoice.

FIG. 3 illustrates a method for preventing healthcare fraud by verifyinguser identity using pre-stored photo information and/or member-specificand provider-specific PINs (or other identification means, such asbiometric identification techniques or the like). For instance, a memberis received at a healthcare provider for a healthcare appointment, andenters a unique PIN, at 130. At 132, a healthcare provider employee(e.g., a receptionist or assistant, or the provider himself or herself)retrieves a photo of the member to be treated (e.g., a primary member, adependent of the primary member, etc.). At 134, the healthcare employeecompares the member to be treated to the photo on file to verify thatthe member is in fact the member to be treated. At 136, uponverification of the member's identity via the file photo comparison, themember is permitted to see the healthcare provider.

FIG. 4 illustrates a method for aggregating payment to a healthcareprovider from a plurality of sources, in accordance with various aspectsdescribed herein. At 150, an invoice is received from a healthcareprovider that has provided a health-related service or product to amember of an employer's health plan. At 152, the healthcare provider isoffered a predetermined percentage of the invoice amount in return foraccepting the predetermined percentage within a predetermined timeperiod. In this manner, the healthcare provider can be rewarded withprompt payment in exchange for accepting less than then full amount ofthe invoice. For instance, the provider may be offered 75% of theinvoice amount if the provider accepts payment within 72 hours of theoffer, 80% if the provider accepts within between 3 and 7 business days,85% if the provider accepts within 7 and 30 calendar days, and so on. Inthis manner, the provider is paid more quickly in return for a reducedfee. In another embodiment, the predetermined percentages and/oracceptance schedule is determined as a function of the service providedor procedure performed by the healthcare provider.

At 154, upon acceptance of the offered amount by the healthcareprovider, a member account (e.g., an HSA, HRA, or the like) is accessedto retrieve funds for payment to the healthcare provider. That is, uponsigning up for the service, the member authorizes the service to accessthe member's HSA as necessary to retrieve funds for paying healthcareinvoices. Additionally, if there are insufficient funds in the member'saccount, the service provider accesses related employer accounts (e.g.,EAA, EBA, employer line of credit, or other employer account(s)) towithdraw additional funds to fully pay the amount listed on the invoice.At 156, funds from the member's HSA and the employer's HRA, EBA, line ofcredit, and/or EAA are aggregated. At 158, each amount withdrawn fromeach account is associated with a UIDN, as described above, tofacilitate transaction tracking and member payback of funds borrowedfrom the HRA, EBA, line of credit, or EAA. At 160, the aggregated fundsare transmitted to the healthcare provider's account to satisfy the debtlisted on the invoice.

In another example the member is permitted to negotiate (e.g., offer areduced payment in exchange for prompt payment of funds from the HSA orthe aggregating account, regardless of whether the member borrows fromthe employer advance account, i.e., regardless of whether the HSA hassufficient funds to cover the invoice amount or the reduced amountoffered). In another example the negotiation is performed automaticallyby the service provider.

The methods illustrated in FIGS. 2-4 may be implemented in a computerprogram product that may be executed on a computer 200 or processor suchas the processor 14 in the system of FIG. 1. Further, it is to beappreciated that any suitable computing environment can be employed inaccordance with the present embodiments. For example, computingarchitectures including, but not limited to, stand alone,multiprocessor, distributed, client/server, minicomputer, mainframe,supercomputer, digital and analog can be employed in accordance with thepresent embodiments.

The computer can include a processing unit such as the processor 16 ofFIG. 1, a system memory such as the memory 16 of FIG. 1, and a systembus that couples various system components including the system memoryto the processing unit. The processing unit can be any of variouscommercially available processors (e.g., a central processing unit, agraphical processing unit, etc.). Dual microprocessors and othermulti-processor architectures also can be used as the processing unit.

The system bus can be any of several types of bus structure including amemory bus or memory controller, a peripheral bus, and a local bus usingany of a variety of commercially available bus architectures. Thecomputer memory includes read only memory (ROM) and random access memory(RAM). A basic input/output system (BIOS), containing the basic routinesthat help to transfer information between elements within the computer,such as during start-up, is stored in ROM.

The computer can further include a hard disk drive, a magnetic diskdrive, e.g., to read from or write to a removable disk, and an opticaldisk drive, e.g., for reading a CD-ROM disk or to read from or write toother optical media. The computer typically includes at least some formof computer readable media. Computer readable media can be any availablemedia that can be accessed by the computer. By way of example, and notlimitation, computer readable media may comprise computer storage mediaand communication media. Computer storage media includes volatile andnonvolatile, removable and non-removable media implemented in any methodor technology for storage of information such as computer readableinstructions, data structures, program modules or other data. Computerstorage media includes, but is not limited to, RAM, ROM, EEPROM, flashmemory or other memory technology, CD-ROM, digital versatile disks (DVD)or other magnetic storage devices, or any other medium which can be usedto store the desired information and which can be accessed by thecomputer.

Communication media typically embodies computer readable instructions,data structures, program modules or other data in a modulated datasignal such as a carrier wave or other transport mechanism and includesany information delivery media. The term “modulated data signal” means asignal that has one or more of its characteristics set or changed insuch a manner as to encode information in the signal. By way of example,and not limitation, communication media includes wired media such as awired network or direct-wired connection, and wireless media such asacoustic, RF, infrared and other wireless media. Combinations of any ofthe above can also be included within the scope of computer readablemedia.

A number of program modules may be stored in the drives and RAM,including an operating system, one or more application programs, otherprogram modules, and program non-interrupt data. The operating system inthe computer can be any of a number of commercially available operatingsystems.

A user may enter commands and information into the computer through akeyboard (not shown) and a pointing device or stylus (not shown), suchas a mouse. Other input devices (not shown) may include a microphone, anIR remote control, a joystick, a game pad, a satellite dish, a scanner,or the like. These and other input devices are often connected to theprocessing unit through a serial port interface (not shown) that iscoupled to the system bus, but may be connected by other interfaces,such as a parallel port, a game port, a universal serial bus (USB), anIR interface, etc.

A monitor (not shown), or other type of display device, may also beconnected to the system bus via an interface, such as a video adapter(not shown). In addition to the monitor, a computer typically includesother peripheral output devices (not shown), such as speakers, printersetc. The monitor can be employed with the computer to present data thatis electronically received from one or more disparate sources. Forexample, the monitor can be an LCD, plasma, CRT, etc. type that presentsdata electronically. Alternatively or in addition, the monitor candisplay received data in a hard copy format such as a printer,facsimile, plotter etc. The monitor can present data in any color andcan receive data from the computer via any wireless or hard wireprotocol and/or standard.

The computer can operate in a networked environment using logical and/orphysical connections to one or more remote computers, such as a remotecomputer(s). The remote computer(s) can be a workstation, a servercomputer, a router, a personal computer, microprocessor basedentertainment appliance, a peer device or other common network node, andtypically includes many or all of the elements described relative to thecomputer. The logical connections depicted include a local area network(LAN) and a wide area network (WAN). Such networking environments arecommonplace in offices, enterprise-wide computer networks, intranets andthe Internet.

When used in a LAN networking environment, the computer is connected tothe local network through a network interface or adapter. When used in aWAN networking environment, the computer typically includes a modem, oris connected to a communications server on the LAN, or has other meansfor establishing communications over the WAN, such as the Internet. In anetworked environment, program modules depicted relative to thecomputer, or portions thereof, may be stored in the remote memorystorage device. It will be appreciated that network connectionsdescribed herein are exemplary and other means of establishing acommunications link between the computers may be used.

It will be appreciated that various of the above-disclosed and otherfeatures and functions, or alternatives thereof, may be desirablycombined into many other different systems or applications. Also thatvarious presently unforeseen or unanticipated alternatives,modifications, variations or improvements therein may be subsequentlymade by those skilled in the art which are also intended to beencompassed by the following claims.

1. A system that facilitates online healthcare fund aggregation forpayment of healthcare provider invoices, comprising: a processor thatexecutes computer-executable instructions for aggregating funds frommultiple healthcare-related accounts for payment to a healthcareprovider; a memory that stores the computer-executable instructions; anda server comprising the processor and the memory and providing Internetaccess to the processor for fund aggregation and healthcare invoicepayment; wherein the instructions comprise: receiving an electronicinvoice from a healthcare provider; accessing a member account belongingto a member of a healthcare plan; withdrawing funds to pay the invoiceamount from the member account, if funds are available in the memberaccount; accessing an employer account maintained by an employerproviding the healthcare plan to the member; withdrawing additionalfunds from the employer account to satisfy the invoice amount when themember account does not have sufficient funds to satisfy the invoiceamount; aggregating the funds from the member account and the additionalfunds from the employer account in an aggregating account (AA); andtransferring the aggregated funds from the aggregating account to ahealthcare provider account to pay the invoice amount.
 2. The system ofclaim 1, wherein: the member account comprises at least one of a healthsavings account (HSA) belonging to a member of a healthcare plan and ahealth reimbursement account (HRA) maintained by the employer of themember; and the employer account comprises at least one of an employeradvance account (EAA), an employer bank account (EBA), and an employerline of credit.
 3. The system of claim 2, wherein the instructionsfurther comprise assigning a unique identification number (UIDN) to eachwithdrawal and transfer of funds.
 4. The system of claim 3, wherein theinstructions further comprise using the UIDNs to track deposits into themember HSA, and, when funds subsequently are deposited into the HSA,transferring funds from the HSA to the EAA until the additional fundswithdrawn respectively therefrom to satisfy the invoice amount arerepaid.
 5. The system of claim 1, further comprising photographic datafor each member of the healthcare plan, stored in the memory andretrievable at a point of service for verifying member identity.
 6. Thesystem of claim 1, the instructions further comprising offering thehealthcare provider a predetermined percentage of the invoice amount inreturn for the healthcare provider accepting the predeterminedpercentage within a predetermined time period.
 7. The system of claim 6,wherein the predetermined percentage increases as a function of time,and wherein the healthcare provider is offered a lower percentage inexchange for prompt payment from the aggregating account and a higherpercentage in exchange for delayed payment from the aggregating account.8. The system of claim 1, the instructions further comprising receivinga member personal identification number (PIN) at a point of service,wherein the member PIN identifies the member as being covered by thehealthcare plan, and receiving a healthcare provider PIN at the time ofinvoice generation by which the healthcare provider verifies that theinvoice is accurate.
 9. The system of claim 1, the instructions furthercomprising triggering a review of the invoice upon a determination thatone or more items listed therein are inconsistent with a predeterminedset of approved items consistent with a diagnosis listed in the invoice.10. The system of claim 9, wherein the healthcare provider is permittedto append to the invoice documentation in support of the items listed inthe invoice.
 11. A computer-executable method of online healthcare fundaggregation for payment of healthcare provider invoices, comprising:receiving an electronic invoice from a healthcare provider; accessing amember account comprising at least one of a health savings account (HSA)belonging to a member of a healthcare plan and a health reimbursementaccount (HRA) maintained by the employer of the member; withdrawingfunds to pay the invoice amount from the member account, if funds areavailable in the member account; accessing an employer accountcomprising at least one of an employer advance account (EAA), anemployer bank account (EBA), and an employer line of credit maintainedby an employer providing the healthcare plan to the member; withdrawingadditional funds from the employer account to satisfy the invoice amountwhen the member account does not have sufficient funds to satisfy theinvoice amount or when the employer plan is required to pay the invoice;aggregating the funds from the member account and the additional fromthe employer account in an aggregating account (AA); and transferringthe aggregated funds from the aggregating account to a healthcareprovider account to pay the invoice amount.
 12. The method of claim 11,wherein: the member account comprises at least one of a health savingsaccount (HSA) belonging to a member of a healthcare plan and a healthreimbursement account (HRA) maintained by the employer of the member;and the employer account comprises at least one of an employer advanceaccount (EAA), an employer bank account (EBA), and an employer line ofcredit.
 13. The method of claim 12, further comprising assigning aunique identification number (UIDN) to each withdrawal and each transferof funds.
 14. The method of claim 13, further comprising using the UIDNsto track deposits into the member HSA, and, when funds subsequently areavailable in the HSA, transferring funds from the HSA to the EAA untilthe additional funds withdrawn therefrom to satisfy the invoice amountare repaid to the EAA.
 15. The method of claim 11, further comprisingstoring photographic data for each member of the healthcare plan, andelectronically retrieving a digital photograph of the member at thepoint of service in order to verify member identity.
 16. The method ofclaim 11, further comprising offering the healthcare provider apredetermined percentage of the invoice amount in return for thehealthcare provider accepting the predetermined percentage within apredetermined time period.
 17. The method of claim 16, wherein thepredetermined percentage increases as a function of time, and whereinthe healthcare provider is offered a lower percentage in exchange forprompt payment from the aggregating account and a higher percentage inexchange for delayed payment from the aggregating account.
 18. Themethod of claim 11, further comprising receiving a member personalidentification number (PIN) at a point of service, wherein the memberPIN identifies the member as being covered by the healthcare plan, andreceiving a healthcare provider PIN at the time of invoice generation bywhich the healthcare provider verifies that the invoice is accurate. 19.The method of claim 11, further comprising triggering a review of theinvoice upon a determination that one or more items listed therein areinconsistent with a predetermined set of approved items consistent witha diagnosis listed in the invoice.
 20. The method of claim 19, furthercomprising permitting the healthcare provider to append to the invoicedocumentation in support of the items listed in the invoice.